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Jacquelyn Palermino

Attenuation Project

February 25, 2018

Wedge Transmission Factor Calculation

Objective: To determine the transmission factor for a 60-degree universal wedge, the impact a
wedge has on the attenuation of a radiation photon beam, and how the wedge factor is used in
monitor unit calculations.

Purpose: A wedge is considered a beam modifying device that is placed within the path of a
radiation beam to alter dose distribution and isodose patterns. It can be used to compensate for
sloped skin surfaces, irregular shaped tumor volumes, and areas of overlap from the use of
intersecting beams.1 Wedges are made from a piece of dense material, usually lead or steel. The
purpose of a wedge is to attenuate the radiation beam progressively across the field, while
providing a more conformal dose distribution within the patient. Wedges have a thicker end
(heel) that attenuates more of the radiation beam then the thinner end (toe). With the use of a
wedge, the intensity of the photons reaching the patient are reduced because some of the initial
photons are being absorbed by the wedge. This results in a tilt of the isodose lines.2

There are two types of wedges available for clinical use, an internal “motorized” wedge and an
external wedge.3 For the purpose of this project, I will be calculating the transmission factor for
an internal wedge. An internal wedge is a single wedge that is located inside the head of the
linear accelerator above the collimator jaws. With the use of an internal wedge, the wedge is
moved into the path of the beam only when needed. If a wedge is present, an increase in monitor
units is necessary to deliver the prescribed dose and compensate for the attenuation of the wedge.
To deliver the correct dose to the patient, a wedge transmission factor needs to be considered for
the decrease in dose.4 The wedge transmission factor (WF) represents the amount of dose
transmitted through the wedge. It is measured on the central axis and is a ratio of the dose with
and without the wedge in the path of the beam. The formula for the wedge transmission factor is
as follows3:

WF = Dose with wedge in path of beam

Dose without wedge in path of beam
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Methods and Materials: Data was collected using an Elekta Infinity linear accelerator for 6MV,
10MV, and 18MV photon energies. The Elekta Infinity linear accelerator utilizes a single
universal 60-degree wedge, which is positioned above the collimator jaws, as a beam modifying
device. To account for the attenuation of the radiation beam with the use of a wedge, a wedge
transmission factor must be used to calculate the amount of monitor units needed to deliver the
appropriate dose. The wedge transmission factor is determined through output measurements
with and without the wedge in the path of the beam.

For the Elekta Infinity, the accelerator output was measured for an open 10x10 cm field size
using solid water phantoms, a thimble Farmer ion chamber, and a Fluke 300v electrometer. Eight
centimeters of a solid water phantom was positioned on the treatment table to reduce any
backscatter caused from the radiation beam. A solid water phantom with a thickness of 2 cm and
a hollow cavity was added and aligned with the crosshair at central axis. An additional 4 cm of
solid water was placed on top for buildup. The temperature within the hollow cavity of the solid
water phantom and the pressure of the room were taken for temperature and pressure correction
factors. The buildup cap of the Farmer ion chamber was removed, and the chamber was placed
inside the hollow cavity. A 10x10 cm field size was used and an SSD of 95 cm was set to the
anterior surface of the solid water phantom. The ion chamber was positioned at 100 cm SAD.

Figure 1. Alignment of solid water phantom with the crosshair and the measurement of
temperature in the hollow cavity where Farmer ionization chamber is placed.
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Figure 2. Farmer ionization chamber with buildup cap removed.

Figure 3. Farmer ionization chamber placed at a depth of 5 cm in solid water phantom.

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The Farmer ion chamber was connected to a Fluke 300v electrometer to record the charged
readings. One hundred monitor units were delivered to the ion chamber using 6MV, 10MV, and
18MV photon energies with a 10x10 cm open field size. The charge was measured and recorded
in nanocoulombs (nC). Each energy was repeated twice, taking into account the charge measured
during delivery, the dose correction factor obtained from data gathered during the annual
machine QA, and the PT,P correction factor (temperature-pressure correction factor). For each
photon energy, an average charge was calculated.

Figure 4. Fluke 300v Electrometer

To assist in calculating the transmission factor for a 60-degree universal wedge, the linear
accelerator output was measured with the wedge placed in the path of the beam. The collimator
was rotated to 90 degrees, allowing the incline of the wedge to fall perpendicular to the ion
chamber. One hundred monitor units were delivered with a 60-degree wedge in the path of the
beam for 6MV, 10MV, and 18MV photon energies. The charge was measured and recorded in
nanocoulombs (nC).

Results: The results for 6MV, 10MV, and 18MV photon beam energies were recorded as shown
in Table 1. An average reading was obtained for each photon energy by using the following
equation:

Average reading of photon energy (nC) = Reading 1(nC) + Reading 2 (nC)

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Table 1. Data collected for charge (nC)measurements of 6MV, 10MV, 18MV photon beams
with and without the use of a 60-degree wedge

Energy Dose without Wedge (nC) Dose with Wedge (nC) Wedge Factor
6 MV [M1 (nC)] 17.455
6 MV [M2 (nC)] 17.453
AVG 6 MV [M (nC)] 17.454 4.398 0.252

10 MV [M1 (nC)] 18.36

10 MV [M2 (nC)] 18.36
AVG 10 MV [M (nC)] 18.36 4.909 0.267

18 MV [M1 (nC)] 19.553

18 MV [M2 (nC)] 19.55
AVG 18 MV [M (nC)] 19.552 5.004 0.256

The Wedge Transmission Factor (WF) was calculated by taking a ratio of the charge/dose
measured with the wedge in the path of the beam over the charge/dose measured with the open
field. This was completed for 6 MV, 10MV, and 18MV photon energies. The wedge factors were
calculated and recorded in Table 1 using the formula3:

WF = Dose with wedge in path of beam

Dose without wedge in path of beam

6 MV WF = 4.398 nC = 0.252
17.454 nC

10 MV WF = 4.909 nC = 0.267
18.360 nC

18 MV WF = 5.004 nC = 0.256
19.552 nC

Discussion: From the data gathered, the WF for a 60-degree universal wedge using a 6 MV
photon beam is 0.252, a 10 MV photon beam is 0.267, and an 18 MV photon beam is 0.256. The
data implies that when the wedge is placed in the path of the beam for the complete delivery of
one hundred monitor units, approximately 75% of the radiation beam will be attenuated by the
60-degree wedge and approximately 25% will be transmitted through the wedge. When a wedge
is added into the path of the beam, the wedge ‘hardens the beam’ therefore reducing the overall
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intensity of the beam while increasing the average energy of the photons. This occurs because
more of the low energy photons from the primary beam are being absorbed by the wedge
whereas the higher energy photons continue to pass through the wedge.
Clinical Application: Glottic larynx treatment with oblique angles. This treatment consisted of
using two beams that were positioned 174 degrees apart from one another. The RAO oblique
beam consisted of using a 273-degree gantry angle with a 78-degree collimator angle and a 2-
degree pedestal angle. The LAO oblique beam used an 87-degree gantry angle with a 282-degree
collimator angle and a 358-degree pedestal angle. Wedges were used on both beams with the
heel of the wedges positioned anteriorly. The prescription was written for a daily dose of 225
cGy for 29 fractions, equaling a total dose of 6525 cGy. The treatment was prescribed to
isocenter and used a universal motorized wedge to help distribute the dose within patient. The
beam weighting for the treatment consisted of the RAO oblique delivering 50.8% of the
prescribed dose and the LAO delivering 49.2% of the prescribed dose. The universal 60-degree
wedge was only inserted into the path of the beam for a portion of the treatment delivery for both
beams. For the RAO oblique, the wedge was inserted for 185.99 MU out of the total 265.0 MU.
For the LAO oblique, the wedge was inserted for 182.34 MU out of the total 259.80 MU. For
each beam, the wedge accounts for 70.2% of the beam and equals a 33° wedge angle. With an
Elekta Infinity linear accelerator, an effective wedge factor needs to be determined to adjust for
the wedge not being in the path of the beam for the entire treatment. To do this, a calculation is
performed using the following equation3:

WF(effective) = WF (given equivalent square at depth) x Wedged MU + Open MU

Total MU Total MU

For this case, a blocked equivalent square and a blocked plus flash equivalent square was
determined. Correction factors and calculations used the blocked plus flash equivalent square of
7 cm. Interpolation was performed to calculate the Wedge Factor (WF) and Tissue Maximum
Ratio (TMR). The Inverse Square Law (ISL) correction factor was also determined for the use in
the monitor unit calculations.
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Figure 5. Calculation of Equivalent Square and Correction for Inverse Square Law.

Figure 6. Wedge Factor for Equivalent Square.

Figure 7 and Figure 8 demonstrate the factor calculations and monitor unit hand calculations for
each field with and without using the wedge factor. If the wedge factor was not used in the
calculation for monitor units, a patient would receive an under dose in treatment. For this
patient’s treatment, the patient would receive an under dose of 52.8% for each beam if the wedge
factor was accidently forgotten in the calculations. The total dose the patient would receive
would be 3445.2 cGy instead of the prescribed total dose of 6525 cGy.
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Figure 7. MU Calculations for RAO and LAO Obliques with the WF.
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Figure 7. MU Calculations for RAO and LAO Obliques without the WF.

Figure 8. Calculations of Percent Difference.

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Figure 9. Photon Beam Dose Calculation MU Sheet

Figure 10. DRR of Larynx Treatment

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Figure 11. Dose Distribution and Wedge Orientation

Figure 12. Plan Report from Pinnacle TPS

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Conclusion: A wedge is an essential beam modifying device used in treatment planning to help
distribute dose more evenly within a patient. It can modify the intensity of the radiation beam by
attenuating more photons at the heel of the wedge versus the toe, therefore changing the isodose
patterns. Wedges are used for treatment planning to compensate for sloped skin surface, irregular
shaped tumor volumes, and areas of overlap from the use of intersecting beams. This project
helped to show the relationship between the use of a wedge and the effects it can have on a
patient’s treatment. By adding a wedge into the beam, it can significantly increase the number of
MUs needed to deliver the correct dose to the patient, decrease the dose rate, and alter the dose
distribution within the patient. Although this can be a beneficial tool, caution must be taken
when planning with wedges. It is always important to check your calculations and the placement
of the wedge. An accidental omission of a wedge during treatment planning will lead to an under
dose of the patient. If a wedge is left out of the treatment field during treatment delivery, an
overdose may occur because there is nothing in the path of the beam attenuating the additional
dose that is calculated for the placement of the wedge.
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References

1. Varatharaj C, Ravikumar M, Sathiyan S, Supe SS. Variation of beam characteristics

between three different wedges from a dual-energy accelerator. Journal of Medical
Physics/Association of Medical Physicists of India. 2011;36(3):133-137.
doi:10.4103/0971-6203.83475.
2. Bentel GC. Radiation Therapy Planning. 2nd. New York, NY: McGraw-Hill; 1996.
3. McDermott PN, Orton CG. The Physics & Technology of Radiation Therapy. Madison,
WI: Medical Physics Publishing; 2010.
4. Armstrong J, Washington CM. Photon dosimetry concepts and calculations. In:
Washington CM, Leaver D, eds. Principles and Practice of Radiation Therapy. 4th ed. St.
Louis, MO: Mosby-Elsevier; 2016. 480-512.